Florida firm to pay $14M over ‘bogus’ Medicare diagnoses
Aug. 3 (UPI) — Florida-based Complete Health will pay a $14.1 million settlement stemming from allegations that it inflated patient diagnoses to overcharge Medicare, the Justice Department said Monday.
DOJ officials said from 2020 to 2023, the company routinely added bogus diagnosis coding to its billing — saying its patients had drug and alcohol dependencies as well as bipolar disorder — that “were not clinically valid.”
Under Medicare Part C, also known as Medicare Advantage, the government pays a fixed monthly rate to private health providers depending on the severity of a patient’s diagnosis.
This differs from Medicare parts A and B, in which a provider is paid fees per service.
DOJ said the Complete Health added the false diagnoses to receive a higher monthly premium per patient.
“Companies that attempt to improperly boost their own profits by reporting bogus medical conditions of Medicare Advantage enrollees — as alleged in this case — will be held responsible for their actions,” said Special Agent in Charge Isaac Bledsoe, of the Department of Health and Human Services Office of Inspector General, in a statement.
“Today’s settlement demonstrates our office’s commitment to safeguarding the integrity of federal health care programs, including Medicare Advantage, which exist to provide necessary care to enrollees, not as a vehicle for improper financial gain,” Bledsoe added.
Complete Health is a management services organization based in Jacksonville that operates in Florida, Alabama and Colorado.
“This settlement sends a strong message to our district, its residents, and medical providers doing business here, that our focus on this vital practice area has not wavered,” said U.S. Attorney Gregory Kehoe, of the Middle District of Florida, in a statement.